Application Form

We will get back to you as soon as possible with a response. Then we can set up a call to discuss your application with you.

First Name

Last Name

Email Address

Physical Address

City

State

Zip Code

Phone Number

How long have you had anxiety?

Why haven’t you been able to solve this anxiety yet?

What is the biggest cost to you of not solving your anxiety?

What is motivating you now to solve your anxiety?

What are your common pattern and obstacles that could get in the way and what will you do to handle them?

How will life look and feel a year from now if you have solved this anxiety problem with my help?

How did you find Dr. Kate to apply?

Complete this sentence: Kate, in practice, I am…Complete this sentence: Kate, in practice, I am…An Avoider, who seeks opportunities but finds reasons I can’t do it because inside I don’t think things can really change.An Excuse-Maker, who signs up for opportunities but then procrastinates because I get nervous about change.A Go-getter, ready to take action with an opportunity and move forward through change.

What will you do to stay on track with the program, no matter your style?

I am agreeing to fully participate, engage and apply the program to the best of my ability. Sign here!